Episode 78: Superior Vena Canva Syndrome Podcast From St Mungo's

Superior Vena Cava syndrome (SVC) may be the first presentation of a cancer and therefore not suspected. The most common symptoms are facial edema, distended neck and/or chest veins, cough and dyspnea. Acute life-threatening symptoms such as airway obstruction from laryngeal edema, cerebral edema, hypotension and coma are possible, but fortunately rare. Over 60% of SVC syndromes are malignant in etiology, with 85% of those due to either lung cancer or lymphoma. Tumors can invade or compress the vessel and predispose to thrombus formation. Benign etiologies are rising in number, and mostly due to intravascular devices, which are often present in cancer patients as well. Diagnosis is dependent on having the clinical suspicion then confirming the diagnosis with imaging, preferably CT chest with contrast or angiogram. Management urgency is based on grading. Grade 4 represents life threatening symptoms requiring emergent intervention with stenting, thrombolysis or angioplasty. Lower grades allow for tissue diagnosis to tailor more definitive therapy to the cancer type: chemotherapy versus radiation therapy. Because SVC syndrome is often found in the later stages of cancer with less than 6 months survival and goals of care should be addressed. However, prognosis is dependent on tumor type. Readily curable cancers such as lymphoma and germ cell tumors long-term survival are expected despite SVC syndrome. In sum, the emergency physician needs to maintain a high level of suspicion when presented with classic symptoms of SVC syndrome, confirm the diagnosis with contrast chest CT and plan for advanced management with cardiology, interventional radiology, oncology or radiation oncology, which may necessitate transfer to a hospital with these capabilities.